Anatomical landmarks for Percutaneous Transhepatic External Biliary Drainage (PTBD)

PTBD is used for temporary decompression of an obstructed biliary system prior to surgical resection as it is believed to reduce major post operative complications. This is preferred over endoscopic biliary stenting (EBS)by most as EBS induces an inflammatory response making resection difficult. For palliation of malignant biliary obstruction and as treatment for common bile duct stones endoscopy is preferred. PTBD is used if endoscopy fails. In this subset internalization for malignancies and surgery for calculi are done once the patient's general condition improve.